A good column in the Boston Globe by Marcia Angell, who is a senior lecturer at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine, titled "High cost for me-too drugs":

Most new drugs are not advances over old ones, but minor variations with new patents and higher prices. In other words, "me-too" drugs. According to FDA classifications, fully 80 percent of drugs that entered the market during this decade are unlikely to be better than existing ones for the same condition.

Drug companies get away with flooding the market with me-too drugs because the FDA doesn't require them to compare new drugs with old ones, just with placebos. So while they may be better than nothing, they might not work better than what people are already taking, and may be worse. The top-selling drug in the world, Lipitor, is one of a class of six me-too drugs, two of which are available as much cheaper generics; they are rarely compared in clinical trials at equivalent doses.

No less an authority than Dr. Robert Temple , director of the FDA's Office of Medical Policy, was quoted in 2004 as saying, "I generally assume these drugs are all the same unless somebody goes out and proves differently. I don't think you lose much if you just always use the cheapest drugs."

The industry inundates doctors with free samples of exorbitantly priced me-too drugs and promotes them to the public as though they were proven medical advances. They aren't...Drug companies protest that lower prices would stifle research, but that argument can't be taken seriously, since they spend over twice as much on marketing and administration as on research and development -- and have more left as profits.